To evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids.
Cross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 μg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L. Validated questionnaires completed to assess QoL, fatigue and sexual function.
Secondary adrenal insufficiency (SAI) was identified on the basis of a failed stimulation test in 22.5% of opioid users vs no controls (P = 0.01). Opioid users with SAI had a higher median morphine-equivalent daily dose (MEDD), P = 0.037–50% with MEDD >200 mg and 0% with MEDD <60 mg had SAI. Among male participants, testosterone was inversely associated with BMI (P = 0.001) but not opioid use. A non-significant trend to low testosterone <8 nmol/L in male opioid users (11/24 opioid users vs 2/14 control, P = 0.08) suggests a small subgroup with opioid-induced androgen deficiency. Opioid users had greater fatigue, reduced quality of life in all subsections of the SF-36 and impaired sexual function in both males and females (all scores P < 0.001 compared to controls).
Long-term opioid therapy was associated with dose-related SAI in over 20% of chronic pain patients and is associated with poor quality of life, fatigue and sexual dysfunction. Obesity confounds the interpretation of opioid induced male androgen deficiency.
European journal of endocrinology. 2018 Sep 10 [Epub ahead of print]
Andrea Lamprecht, Jane Sorbello, Christina Jang, David J Torpy, Warrick J Inder
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia, Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,, Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia